Imaging Features of Multiple Myeloma Extramedullary Lesions in the Liver with 18F-FDG PET/CT, Contrast-Enhanced CT and MRI

Hypervascular nodular hepatic involvement in multiple myeloma: A case report

Multiple myeloma (MM) presenting as multiple hypervascular nodular hepatic infiltration is rare. We report a case of liver involvement of MM in 62-year-old woman presenting as multiple hepatic nodules with arterial enhancement and delayed washout. As in our case, the inclusion of MM in the differential diagnosis of multiple hypervascular hepatic nodules should be considered despite of its rarity.

Clinical and radiological presentations of ovarian plasmacytoma

BACKGROUND

The occurrence of extramedullary plasmacytoma (EMP) in the ovaries is rare. Here, we describe the clinical, pathological and radiological presentations of ovarian plasmacytomas to improve the differential diagnosis of this disease. Also, the reasons for misdiagnosis, clinical manifestations and radiological features were discussed through a literature review.

CASE PRESENTATION

A 54-year-old woman was suspected to have EMP upon routine ultrasound examination and was subsequently diagnosed using pathological examination of the left ovarian mass. The radiological features of this case included (1) a solitary soft-tissue mass in the left ovary with clear boundaries; (2) a homogeneous mass with medium-density without necrosis, which was homogeneously enhanced after contrast medium injection; and (3) magnetic resonance imaging showing a homogeneous lesion with isointense signals on T1- and T2-weighted imaging, restricted diffusion on diffusion-weighted imaging, and a low apparent diffusion coefficient value of approximately 0.72×10^-3 mm²/s, which was significantly and homogeneously enhanced after contrast medium injection with a rapid rise-slow decay type, and with thickened vascular shadows around the lesion.

CONCLUSIONS

EMP in the ovary is rare and only a few cases have been reported. We reviewed EMP-related literature and the summarized the clinical manifestations, radiological features and treatment strategies of this disease to help the diagnosis and management. Application of second-line drugs might be a viable strategy to improve the survival rate of patients and to prevent the progression to a certain extent.

PET/CT Variants and Pitfalls in Liver, Biliary Tract, Gallbladder and Pancreas

A wide variety of pathological anomalies may occur in the liver, biliary system, and pancreas. It is a necessity to use many different imaging techniques in order to distinguish such varied pathologies, especially those from malignant processes. Positron Emission Tomography/Computed Tomography (PET/CT) is an imaging method that has proven its diagnostic value in oncology and can be used for different clinical purposes. Fluoro-18 fluoro-2-deoxy-D-glucose has a wide range of uses as a dominant radiopharmaceutical in routine molecular imaging, however, molecular imaging has started to play a more important role in personalized cancer treatment in recent years with new Fluoro-18 and Gallium-68 labeled tracers. Although molecular imaging has a strong diagnostic effect, the surprises and pitfalls of molecular imaging can lead us to unexpected and misleading results. Prior to PET/CT analysis and reporting, information about possible technical and physiological pitfalls, normal histological features of tissues, inflammatory pathologies, specific clinical features of the case, treatment-related complications and past treatments should be evaluated in advance to avoid misinterpretation. In this review, the physiological and pathophysiological variants as well as pitfalls encountered in PET/CT imaging of the liver, biliary tract, gallbladder, and pancreas will be examined. Other benign and malignant pathologies that have been reported to date and that have led to incorrect evaluation will be listed. It is expected that the devices, software, and artificial intelligence applications that will be developed in the near future will enable much more effective and faster imaging that will reduce the potential causes of error. However, as a result of the dynamic and evolving structure of the information obtained by molecular imaging, the inclusion of the newly developed radiopharmaceuticals in routine practice will continue to carry new potentials as well as new troubles. Although molecular imaging will be the flagship of diagnostic oncology in the 21st century, the correct analysis and interpretation by the physician will continue to form the basis of achieving optimal performance.

Extramedullary multiple myeloma involving the liver and periportal lymph node, diagnosed by EUS-FNA in a patient with cirrhosis

Extramedullary multiple myeloma (EMM) involving the liver as a focal space-occupying lesion is very rare, especially in the patients with cirrhosis. Here, we report a case of EMM in the liver and periportal lymph node, diagnosed by endoscopic ultrasound guided-fine-needle aspiration (EUS-FNA). A 57-year-old male patient, with history of cirrhosis, presented with abdominal pain and pancytopenia. The abdominal magnetic resonance imaging (MRI) demonstrated a 6.5 cm left hepatic mass with a 1.1 cm malignant-appearing periportal lymph node and diffuse osseous lesions. The cytology specimens from the hepatic mass and the periportal lymph node were obtained through EUS-FNA without rapid on-site evaluation (ROSE). The thin-layer preparations (ThinPrep) showed abundant plasmacytoid cells, which were confirmed to be Kappa-restricted neoplastic plasma cells by the cell block preparations. Later, his serum level of Kappa light chain was found significantly elevated by flow cytometry, which was identified as monoclonal IgA Kappa light chain by serum protein electrophoresis (SPEP) with immunofixation. The patient was diagnosed as IgA multiple myeloma with extramedullary involvement of the liver and periportal lymph node. This is the first case showing the ThinPrep cytomorphologic features of EMM in the liver and periportal lymph node. This case highlights the importance of distinguishing plasma cells from being hepatocytes and lymphocytes on the ThinPrep and also emphasizes the utility of the cell block in the diagnosis of plasma cell neoplasm.